Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example

Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example

The patient case involves a 46-year-old Caucasian man diagnosed with a generalized anxiety disorder (GAD). GAD is a psychotic disorder that affects at least 21% of adults in their lifetime. Studies have shown that GAD symptoms include extreme worry and anxiety over critical social issues, which are difficult to control and impairing across varied contexts (Patriquin & Mathew, 2017). In this case, the client endorses the feeling of nervousness, reports occasional feelings of impending doom, and worries about work. Moreover, the client describes his mood as bleh, which denotes a feeling of physical uneasiness, general discomfort, or mild depression. Clinical trials have shown that GAD has high comorbidity leading to poor diagnostic reliability with varied condition forecasters and symptoms of major depressive disorder (MDD) and GAD, with GAD being a precursor of MDD (Patriquin & Mathew, 2017; Regier et al., 2013). In this case, a definitive diagnosis is necessary with the physician’s baseline evaluation of the patient’s symptoms related to physical health (Asher & Aderka, 2018). For this case, Hamilton Anxiety Rating Scale (HAM-A) score ≥ 26 indicates severe anxiety. Wherefore, GAD diagnosis involves evaluating a client’s psychological symptoms and comparing them to the DSM-5 criteria. This paper examines a case scenario involving a GAD client and  (Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example)

Decision Point 1

As a PMHNP caring for a GAD patient, Paxil 10 mg PO daily is the first choice pharmacological therapy for this patient. Paxil is an SSRI that is considered a first-line treatment for GAD. Paxil was shown to be safe and well-tolerated, potently inhibits 5- hydroxytryptamine reuptake, and blocks the reuptake of norepinephrine and dopamine to some extent in randomized control trials and double-blind studies (Strawn et al., 2018). Besides, Paxil was shown to significantly improve HAM-A scores and improve anxiety symptoms and daily functioning.(Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example)

The aim is to improve the patient’s anxiety symptoms. Imipramine and Buspirone were not selected. Imipramine is a tricyclic antidepressant, and although it is effective in controlling worrying in GAD patients, there is limited information on its efficacy on depressive symptoms and only used as a third-line option for anxiety disorders (Garakani et al., 2020). Besides, it has anticholinergic and antiadrenergic side effects that limit its use. Equally, Buspirone was not selected since it is only recommended for short-term treatment of anxiety symptoms (Wilson & Tripp, 2018). GAD is chronic, and Buspirone’s long-term efficacy has not been established. Besides, Buspirone is an anxiolytic used as a second-line treatment for anxiety disorders. The ethical consideration at this point is informed consent and beneficence (Beck, Kim, & Dunn, 2021). As a PMHNP, I am committed to providing informed consent and acting in a way that provides the best benefit to the patient. In this case, the treatment decision is based on available evidence on the efficacy of SSRIs compared to other recommended anxiety pharmacological agents. Therefore, Paxil was the most preferred medication with the highest benefit to the patient.(Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example)

Decision Point Two

At this point, the initial Paxil 10 mg PO daily yielded significant improvement in the patient’s symptoms after two weeks. The best decision is to increase the dosage to 20mg PO daily. The client reported no chest tightness or shortness of breath and no worries, and the HAM-A score decreased to 18, indicating moderate to severe anxiety (Hamilton, 1959). Therefore, there is no need for therapeutic substitution, but titrate and continue the current medication. Paxil 20mg PO daily is well tolerated and associated with optimal benefits (Shrestha, Fariba, & Abdijadid, 2021). At this point, the goal of treatment was to provide a dosage that alleviated the patient’s anxiety symptoms while reducing the potential side effects. (Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example)

Achieving optimal medication response and reducing potential side effects such as loss of gastrointestinal complaints, appetite, sweating, sleep disturbance, or drowsiness were critical for medication compliance. Starting Paxil at a low dose and gradually increasing the dosage reduces the risks of side effects. The choice to increase the dosage to 40 mg PO daily and no change in drug/dose at the time were not selected. A higher dosage of Paxil is associated with an increased risk of somnolence and discontinuation (Nevels, Gontkovsky, & Williams, 2016). I chose not to retain the current dosage since the patient’s symptoms are still evident and cause impairment of social functions. The ethical considerations at this point are nonmaleficence and beneficence (Beck, Kim, & Dunn, 2021). As a PMHNP, I commit not to harm my patient. Retaining the current dosage had no potential benefit to the patient while increasing the dosage posed risks of side effects to the patient.(Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example)

Decision Point Three

The best decision is to maintain the current medication and dosage. The patient presented a significant increase in symptom reduction (61%), and the HAM-A score decreased to 10. The other significant consideration for this decision is the tolerance for the medication and the lack of significant side effects. Like in the previous decision point, the client tolerates the present dosage with optimal benefits. Therefore, there was no need to increase the dosage to 30 mg PO daily to avoid potential side effects (Nevels, Gontkovsky, & Williams, 2016). Had the patient presented no improvement in symptoms, there would have been a need to titrate the dosage. However, the 30 mg PO daily is the optimal Paxil dosage, with maximum benefits to the patient and zero side effects.(Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example)

Moreover, augmenting the medication with Buspirone was not considered due to potential risk. In rare cases, Buspirone and paroxetine increase Serotonin syndrome risks associated with hallucination, shivering/sharking, increased heart rate, nausea, muscle spasm, incoordination, and fever (Garakani et al., 2020). The other potential Buspirone and Paxil augmentation side effects include seizures, high blood pressure, blurred vision, and tremor. Besides, the patient has a history of alcohol abuse, which is a significant contraindication for Buspar as it increases the drug’s side effects on the Central Nervous System, leading to harmful drug interactions and severe impairments (Garakani et al., 2020). Typically, augmentation of SSRs is recommended only when the patient does not respond to the first-line medication or does not tolerate the side effects. Like previous decision points, the goal of treatment is to alleviate patient symptoms and reduce the side effects of medication. As a PMHNP, this was central to achieving long-term goals for medication compliance and zero relapses in anxiety and depressive symptoms. At this point, the ethical consideration is to avoid harm (Beck, Kim, & Dunn, 2021), which justifies the need to retain the current dosage or avoid augmentation. Equally, it is critical to follow up with the patient to ensure compliance and response to any potential side effects.(Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example)

Conclusion

Serotonin-norepinephrine reuptake inhibitors (SNRIs), anxiolytics, and tricyclic antidepressants are all recommended to treat anxiety symptoms. However, Serotonin-norepinephrine reuptake inhibitors are the recommended first-line treatment for generalized anxiety disorder. In this case, Paxil was the best choice for the patient since the other choices, Imipramine and Buspirone, belonged to tricyclic antidepressant and anxiolytics pharmacological classes, respectively. While Imipramine is recommended as a third-line option for anxiety disorders, Buspirone is a second-line treatment for anxiety disorders. As a PMHNP, the primary obligation is to make clinical decisions with optimal benefit to the patient with limited or zero side effects. The need for optimal benefits justifies the selection of Paxil for GAD treatment.(Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example)

As a PMHNP, it is vital to consider the patient’s medical history, potential comorbid conditions, and factors that cause the patient’s symptoms or are likely to limit the efficacy of the treatment plan. Equally, it is critical to consider the ethical tenets of psychiatric practice. This protects the psychiatrist and patient from the ethical ramifications of treatment decisions. These include legal suits for making and adverse patient responses to medications. Ensuring patient safety help reduce risks, harm, and error, which may occur during treatment and are critical to quality health services. Therefore, follow-up is vital for monitoring the patient, and clear communication ensures voluntary participation in the treatment. Transparency is key to achieving compliance and positive patient outcomes when discussing the treatment plan.(Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example)

References

Beck, N. S., Kim, D. S., & Dunn, L. B. (2021). Ethical Issues in Psychopharmacology. Focus, 19(1), 53-58. (Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example)https://doi.org/10.1176/appi.focus.20200043

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: current and emerging treatment options. Frontiers in psychiatry, 1412. (Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example)https://doi.org/10.3389/fpsyt.2020.595584

Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0(Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example)

Nevels, R. M., Gontkovsky, S. T., & Williams, B. E. (2016). Paroxetine—the antidepressant from hell? Probably not, but caution is required. Psychopharmacology Bulletin, 46(1), 77.(Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5044489/

Patriquin, M. A., & Mathew, S. J. (2017). The neurobiological mechanisms of generalized anxiety disorder and chronic stress. Chronic Stress, 1, 2470547017703993(Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example). https://doi.org/10.1177%2F2470547017703993

Regier, D. A., Narrow, W. E., Clarke, D. E., Kraemer, H. C., Kuramoto, S. J., Kuhl, E. A., & Kupfer, D. J. (2013). DSM-5 field trials in the United States and Canada, Part II: test-retest reliability of selected categorical diagnoses. American Journal of Psychiatry, 170(1), 59-70.(Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example) https://doi.org/10.1176/appi.ajp.2012.12070999

Shrestha, P., Fariba, K., & Abdijadid, S. (2021). Paroxetine(Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example). https://www.ncbi.nlm.nih.gov/books/NBK526022/

Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opinion on Pharmacotherapy, 19(10), 1057-1070. (Generalized Anxiety Disorder Comprehensive Solved Nursing Essay Example)https://dx.doi.org/10.1080%2F14656566.2018.1491966